“I can’t handle letting them eat all this junk food.”
“My sister keeps sending me videos about Paleo and thinks it will help my son’s ADHD and anxiety, but dairy and bread and crackers are his go-to’s.”
Worry about nutrition can fuel counterproductive feeding
What does this mean? How does this impact our families and our practice? What can we do with a responsive lens to help?
Anxiety about nutrition and what kids eat are among the main worries that negatively impact feeding. Social media is awash in anxiety-provoking content: Pediasure commercials play on parent guilt (what parent wouldn’t “do anything for your everything”), friends and in-laws brag that their children love green smoothies; and a child’s primary care doctor pushes vegetables, when calories may be a more immediate concern (ironically increasing pressure usually leads to fewer veggies consumed).
Alas, the worry around nutrition contributes to trying to get kids to eat, which often invites resistance. Research is clear that pressure to eat tends to backfire. (We’ll explore pressure to eat research as well as nutrition misperceptions in future posts and webinars.)
When children are fed from a place of anxiety and avoidance (sugar, white flour, processed foods, fast foods, convenience foods, dairy, and gluten are bad, toxic, poisonous for example), it can add anxiety to an already tense situation.
What can professionals working with children with feeding challenges do to counteract nutrition worry and pressure while supporting families?
View and talk about foods in neutral terms*
When speaking with parents and children about food, stay neutral and descriptive, as in: crunchy, sweet, pre-packaged, homemade, noodles, fruit…
Avoid: junk, crap, healthy or unhealthy, even growing vs. play foods. Children learn that words like “growing” mean good, and “play” (or “sometimes”) mean bad. For children who may already feel shame, or bad about their eating abilities or the foods they prefer, this won’t help. And their parents will also feel shame and that they have failed.
Do: Make sure your resources are food neutral. We like this example from Thrive with Spectrum Pediatrics (two of our TEAM members LINK HERE) that uses neutral words like “refrigerated,” “aisle,” and “produce” to describe food options for different needs.
Coach parents to do the same.
Avoid nutrition “education”
Young children aren’t able to understand standard nutrition education messages. Trying to get them to eat by extolling the health virtues of a food isn’t likely to help, and may reinforce feelings that they are letting parents and helpers down. Nutrition education can pressure and backfire. Avoid phrases such as, “Milk will make your muscles and bones big and strong.”
Reflection: “Why am I saying or doing this around the food?”
If the answer is to try to get a child to take a bite, it will likely be felt as pressure.
Is there a legitimate nutrition worry?
Make sure parents’ worries are heard. Having a pediatric RD on your team or referring to a trusted and responsive RD (if you aren’t one) can reassure parents, and tailor any supplements if needed.
Reassure about nutrition when you can
For example, non-RDs can ask for a typical day (or three) food intake (here is a sample intake journal) and in most cases can use a simple protein formula (see Nutrition Notes: Protein for an example) to reassure parents. Most of our clients get more protein than parents think.
If parents like/request more resources, share reassuring articles, podcasts, or videos from allied professionals, such as this article debunking food and sugar addiction.
Reassure that nutrition tends to even out over a day or a few days. If the pressure is on to make each meal “balanced,” it can backfire. Few children eat from each food group, or “recommended amounts” at each meal.
Support nutrition while working on feeding
This too will be contextual. This may mean homemade blended formula in a feeding tube; supplements for some; shakes, smoothies or smoothie pops or protein drinks within an RF framework; fortified versions of accepted foods (whole grain Goldfish); offering frozen and canned foods. (Frozen and canned are not lesser-than, and are often more accepted by selective eaters due to their predictability. They also tend to be more affordable and available from community pantries.)
Seek to understand individuals’ social, historical, and cultural contexts, and practice with cultural humility*
Avoid shaming favored foods within a culture, such as white rice, flour tortillas, or fried foods. Learn about the communities you serve. Offer resources that include relevant cultural foods. Consider how standard nutrition education materials such as MyPlate, with the visual of Western foods: typically a lean meat, veggie and whole-grain or starch for each meal may not work for every client (or even most of them).
Consider societal inequities which may impact interventions, including food insecurity*
Does the family have enough food? Food insecurity is tragically common, and more so in communities of color. Food insecure children can experience feeding challenges too.
Honor enough first. Learn about local resources to refer to. Screen for food insecurity. This article (content warning for anti-fat bias) has screening recommendations and sample questions. The USDA has a six-question inventory to assess FI.
Nutrition, of course, matters. But often the worry and pressure around aiming for better nutrition hamper meaningful progress. Remind parents that early progress won’t likely be eating roasted cauliflower right away. Help them resist falling back into pressure by pointing out progress around comfort, calm at mealtimes, curiosity and early explorations. (Future posts will explore non-food-related ways to support a child’s health and wellbeing.)
Questions to ponder
What resources have you found helpful to address parent anxiety around nutrition?
Do you have any go-to resources for shopping and cooking when resources such as money, time and cooking infrastructure (fridge, stove, electricity) are limited?
Reassuring resources you may want to check out and share with worried parents:
Comfort Food Podcast
Virginia Sole Smith’s Burnt Toast newsletter (also has a focus on fat acceptance and social justice), particularly this piece about processed foods
Katja, Jo and Natalia